Abstract

Aeration of nasal turbinates are named as concha bullosa. Concha bullosa is an often seen diversity of turbinates.but concha bullosa in another concha bullosa is never reported. Here is a thirty year old woman whish was presented of concha bullosa in a concha bullosa.

Keywords: Nasal pathology; Concha bullosa; Rhinorrhoea; Turbinate

Keywords

Nasal pathology; Concha bullosa; Rhinorrhoea; Turbinate

Introduction

The turbinates are important structures originated from the lateral
wall of the nose . Concha Bullosa is an air pocket in the turbinate [1].
Concha bullosa is a very common anatomical deviation of turbinates.
Cyctic distension can be found in all turbinates [2,3]. But there are
small number of reports about a case with concha bullosa in concha
bullosa [4]. Here we describe a patient who has nasal obstruction due
to concha bullosa in concha bullosa.

Case Report

A 30 year-old woman was admitted to our clinic with complaints
of rhinorrhoea and nasal obstruction. She had suffered with these
symptoms for several years. Nasal examination showed large middle
turbinates and nasal discharge. She was treated with oxymetazoline
hydrochloride 0.005%. But there was no improvement in her
symptoms. A computed tomography (CT) scan of her paranasal
sinuses was performed. CT of the paranasal sinuses showed concha
bullosa in middle turbinates. But there is concha bullosa in concha
bullosa in left side of her nose (Figures 1 and 2). In addition,
discharge in nasal cavity was also observed. The patient underwent
endoscopic sinus surgery under general anaesthetic. Intra-operative
examination showed hypertrophy of middle turbinates. The middle
concha bullosas were resected but there was another concha bullosa
in left concha bullosa. The endoscopic examination that was done one
month after the operation and her nasal obstruction had improved
significantly.

Discussion

Concha bullosa is a cystic inflation of the nasal turbinate and the
most frequent alteration of the sinonasal region [1,2]. It is commonly
concured in the middle concha. It is seldom found in the superior
and inferior conchae. Presence of bilateral conchae bullosa alines between 45%-61.5% [3,5]. But there was only one case with air cells
in all turbinates [6]. Also anatomical variation of concha bullosa
in concha bullosa is extremely rare. Comparative studies including
asymptomatic patients and sinusitis patients have informed that
concha bullosa is more often encountered in patients with sinusitis
[3-5]. There are articles show that the size of concha bullosa is
consequential for sinusitis’s signs and headache [2]. Conclusion
In patients with sinusitis and nasal obstruction, concha bullosa in
concha bullosa (double concha bullosa) must be kept in the mind.